Women of childbearing age with congenital heart defects have often been told pregnancy could be life-threatening so it should be avoided. That’s not true today.
About 1.3 million U.S. adults were born with heart defects, and more than half are women, according to the Adult Congenital Heart Association. Women of childbearing age with complex congenital heart defects — serious abnormalities of the heart's structure — have often been told pregnancy could be life-threatening so it should be avoided.
But thanks to advances in monitoring and caring for women with congenital heart disease throughout and after pregnancy, pregnancy in women with continental heart disease is no longer an elusive dream for most women born with heart defects.
Heart defects and pregnancy
The American Heart Association has published a scientific statement with research-backed guidance to help women with congenital heart disease and their doctors manage successful pregnancies, childbirth and post-natal care.
"Women with complex congenital heart disease were previously advised to not get pregnant because of the risk to their life," said UCLA School of Nursing lecturer Mary M. Canobbio, RN, who headed the writing committee for the new scientific statement. "Now scientific research demonstrates that with proper management in the hands of experienced cardiologists and obstetricians, these women can have successful pregnancies."
Complex congenital heart disease includes defects such as being born with only one of the two chambers, ventricles, that pump blood in the heart; transposition of the great arteries, in which the two main arteries leaving the heart are reversed in position; aortic valve stenosis, a sometimes severe narrowing of the aortic valve on the left side of the heart; and a type of high blood pressure, pulmonary hypertension, affecting arteries in the lungs.
When children are born with these and other serious heart conditions, they need immediate medical care — and their heart health typically needs extra monitoring for the rest of their lives. The good news is that most females born with congenital heart disease will do well with proper cardiology care as they grow up and become adults. And now, for the first time, many who reach childbearing age disease can look forward to having children of their own.
While there remains a moderate-to-high risk for both a mom-to-be with congenital heart disease and her unborn child, heart specialists skilled in managing any problems that arise have greatly lessened the odds a pregnancy will have serious problems, according to the American Heart Association guidelines.
“This scientific statement outlines the specific management for these high-risk patients,” Canobbio said. “What we know about the risks for these patients, what the potential complications are, what cardiologists, advanced practice nurses and other cardiac health providers should discuss in counseling these women, and once pregnant, recommendations in terms of the things we should be looking out for when caring these women.”
In order to have a clear and realistic understanding about how their specific heart abnormalities could impact their health and their babies, medical counseling is key for any woman with a congenital heart defect who is considering pregnancy. Then, as soon as she learns she’s expecting, she and her doctors need to make a plan spelling out any problems that could happen during and after delivery — and noting how these potential complications can be prevented or treated.
Managing heart disease during pregnancy
The authors of the new guidelines recommend pregnant women with congenital heart defects should deliver their babies at medical centers where a cardiologist experienced in managing complex congenital heart disease is on staff, along with obstetricians trained in high risk maternal-fetal medicine, a cardiac anesthesia expert, and a cardiac surgical team.
After her baby is born, the new mom should continue to be followed closely by her cardiologist as long as indicated. because the effects of pregnancy can impact the woman for at least six weeks and as long as six months.
June 29, 2017
Christopher Nystuen, MD, MBA